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Preserved physical fitness is associated with lower 1-year mortality in frail elderly patients with a severe comorbidity burden
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Department of Physiotherapy, NU Hospital Group, Trollhättan, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Department of Research and Development, NU Hospital Group, Trollhättan, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Internal and Acute Medicine, NU Hospital Group, Trollhättan-Uddevalla, Sweden.
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2019 (English)In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 14, p. 577-586Article in journal (Refereed) Published
Abstract [en]

Introduction: Physical deterioration in connection with a care episode is common. The aim of this study was, in frail elderly patients with a severe comorbidity burden, to analyze 1) the association between physical fitness measurements and 1-year mortality and 2) the association between preserved physical fitness during the first three months after discharge from emergency hospital care and 1-year prognosis.

Methods: Frail elderly patients (≥75 years) in need of inpatient emergency medical care were included. Aerobic capacity (six-minute walk test, 6MWT) and muscle strength (handgrip strength test, HS) were assessed during the hospital stay and at a three-month follow-up. The results were analyzed using multivariate Cox regression; 1) 0–12-month analysis and 2) 0–3-month change in physical fitness in relation to 1-year mortality. The analyses were adjusted for age, gender, comorbidity and frailty.

Results: This study comprised 408 frail elderly hospitalized patients of whom 390 were evaluable (mean age 85.7 years, Charlson’s index mean 6.8). The three-month mortality was 11.5% and the 1-year mortality was 37.9%. After adjustments, the Cox-regression analysis showed that both 6MWT and HS were associated with 1-year mortality, HR6MWT 3.31 (95% CI 1.89–5.78, p<0.001) and HRHS2.39 (95% CI 1.33–4.27, p=0.003). The 0–3-month change in the 6MWT and the HS were associated with 1-year mortality, where patients who deteriorated had a poorer prognosis than those with improved fitness, HR6MWT 3.80 (95% CI 1.42–10.06, p=0.007) and HRHS 2.21 (95% CI 1.07–4.58, p=0.032).

Conclusion: In frail elderly patients with a severe comorbidity burden, physical fitness in connection with emergency hospital care was independently associated with 1-year mortality. Moreover, a change in physical fitness during the first months after hospital care was important for the long-term prognosis. These results emphasize the importance of providing hospital care designed to prevent physical deterioration in frail elderly patients.

Place, publisher, year, edition, pages
Auckland, New Zealand: Dove Medical Press Ltd.(Dovepress) , 2019. Vol. 14, p. 577-586
Keywords [en]
frail elderly; mortality; physical fitness; six-minute walk test; handgrip strength test; in-hospital rehabilitation
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:liu:diva-156220DOI: 10.2147/CIA.S198591ISI: 000462319100001PubMedID: 30936688OAI: oai:DiVA.org:liu-156220DiVA, id: diva2:1303207
Note

Funding Agencies|NU Hospital Group, Department of Research and Development

Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-04-15Bibliographically approved

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Åhlund, KristinaEkerstad, NiklasBäck, MariaÖberg, Birgitta
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